Clinical and operational value of the extensively drug-resistant tuberculosis definition
Clinical and operational value of the extensively drug-resistant tuberculosis definition
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DOI：
10.1183/09031936.00077307
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发表时间：
2007-10-01
影响因子：
24.3
通讯作者：
Raviglione, M. C.
中科院分区：
文献类型：
--
作者：
Migliori, G. B.;Besozzi, G.;Raviglione, M. C.
目前，没有资料表明对不同于异烟肼和利福平的一线药物的耐药性/敏感性对决定广泛耐药结核病(XDR-TB)患者预后的影响，以及与对所有一线抗结核药物的耐药相比，XDR-TB是否是较差的临床结果的更准确的指标。根据世界卫生组织的建议，对所有研究地点的一线和二线抗结核药物进行药敏试验、质量保证和治疗。在分析的4,583例培养阳性结核病病例中，361例(7.9%)为耐多药，(1.4%)为广泛耐药。与对所有一线药物(异拉齐德、利福平乙胺丁醇、链霉素，在检测时，还有吡嗪酰胺)耐药的耐多药结核病病例相比，广泛耐药结核病病例出现不良结局的相对风险(RR)为1.58，与“其他”耐多药结核病病例(那些对乙胺丁醇、吡嗪酰胺和链霉素中至少一种一线抗结核药物敏感的病例，无论对未定义XDR-TB的二线药物的耐药性如何)相比，相对风险为2.61。广泛耐药结核病的出现证实了结核病管理中的问题仍然存在。在等待新的工具来促进广泛耐药结核病的管理的同时，应紧急确保获得高质量的诊断和治疗服务，并应迅速实施适当的公共卫生政策，以防止耐药性的进一步发展。
Currently, no information is available on the effect of resistance/susceptibility to first-line drugs different from isoniazid and rifampicin in determining the outcome of extensively drug-resistant tuberculosis (XDR-TB) patients, and whether being XDR-TB is a more accurate indicator of poor clinical outcome than being resistant to all first-line anti-tuberculosis (TB) drugs.To investigate this issue, a large series of multidrug-resistant TB (MDR-TB) and XDR-TB cases diagnosed in Estonia, Germany, Italy and the Russian Federation during the period 1999-2006 were analysed. Drug-susceptibility testing for first- and second-line anti-TB drugs, quality assurance and treatment delivery was performed according to World Health Organization recommendations in all study sites.Out of 4,583 culture-positive TB cases analysed, 361 (7.9%) were MDR and 64 (1.4%) were XDR. XDR-TB cases had a relative risk (RR) of 1.58 to have an unfavourable outcome compared with MDR-TB cases resistant to all first-line drugs (isonlazid, rifampicin ethambutol, streptomycin and, when tested, pyrazinamide), and an RR of 2.61 compared with "other" MDR-TB cases (those susceptible to at least one first-line anti-TB drug among ethambutol, pyrazinamide and streptomycin, regardless of resistance to the second-line drugs not defining XDR-TB).The emergence of extensively drug-resistant tuberculosis confirms that problems in tuberculosis management are still present in Europe. While waiting for new tools which will facilitate management of extensively drug-resistant tuberculosis, accessibility to quality diagnostic and treatment services should be urgently ensured and adequate public health policies should be rapidly implemented to prevent further development of drug resistance.